RC-12-803 (3) _ Miami Shores Village F -
s
Building Department SEP 0 5 Z81Z
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.M)° ).2— 1
PERMIT APPLICATION Master Permit No.'
FBC 20 tO
Permit Type: MECHANICAL „�,j/ �,
OWNER:Name(Fee Simple Titleholder): - cd—vz-
Address: ��tP.� e i c;.
City: State:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 2- S
City:M Ca ate,) Miami Shores County:_�� [ Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: J " Al. Are-C'. 5e_ro/('ej Phone#: Oltu 0/9
Address:
City: I eirn i
I
Qualifier Name: U •�� Phone#: (3f6) ,2.51_e 0/(J
State Certification or Registration#: �s cate of Competency#:
Contact Phone#:O-%2 251-0''/ Email Address: dd 6 1S0 1 a17e
DESIGNER:Architect/Engineer: Phonek
Value of Work for this Permit:$ 0() Square/Linear Footage of Work: �!J
Type of Work: ❑Address ❑Alteration ❑New] ❑Rep ' /Replaceej j ❑Demolition
Description of Work:�-�i/�1®y �®l �Q l �� 5 G► Tj ��11
a
s
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
i
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER' YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no a approved and a reinspection fee will be charged.
Signature A :2L,/I I I
Sig re h�(b,,
Owner or Agent Contractor
The foreoing instrument was acknowledged before in i se foregoing instrument was acknowledged before me this
day of �by� �� day of ,20 by ��D
who i me or who has producer o is persona no to me or who has produced
#� s
As identification an t eT+l. as identification and who did take an oath.
NOTARY PUBLIC: a ' I �% NOTUBLIC:
Ail 03 :_
Sign:
,t z Sign:
Print 'y • :� @� a��� Print. 1
%W7 ��� ,Pt', RITAM.MILIAN
My Commission Expires: !� ed1e`9l" My Commission Expires: ; : " Y00M:SSION@dD93284g
EXPIRES:February 14,2014
I Rf Ott ' Bonded Thni Notary Publo Urdwmftn
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APPROVED BY " miner Zoning
g
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
J ,
Miami Shores Village
Ins,, 8�� Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305) 795.2204
Fax:(305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications.Each unit change-out must be on its own data
sheet.Multiple units on single sheets are not acceptable.
Job Address(where the work is being done): 3 4:1 1 P2 e q2f
City: Miami Shores Village County: Miami Dade Zip Code: �313 8
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI(AHRI)DATA SHEET REQUIRED
Change Disconnecting means:YES ❑ NO ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑
UNIT BEING REPLACED DATA NEW UNIT
ZLW MANUFACTURER
AHU or PKG.UNIT MODEL# AM F60 9)
COND.UNIT MODEL# Q Lei
10 KVJ KW HEAT 10 XW
NOM TONS $ ,,
AHU CU PKG 1 M.C.A AHU CU PKG
AHU CU PKG 2 M.O.P AHU CU PKG
AHU CU PKG 3 VOLTS AHU CU PKG
PKG UNIT I 1 PKG UNIT / I
EER/SEER
YES NO REPLACING DUCTS YES 0
YES NO REPLACING THERMOSTAT YES 0
YES NO NEW 4"CONCRETE SLAB YE -
v0-YES NO NEW ROOF STAND ES
YES NO NEW RETURN PLENUM BOX YES
1. Minimum Circuit Ampacity(Wire Size): a►'Xa4\e' 8
2. . Maximum Overcurrent Protection(Fuse/Breaker Size): U
3. Voltage of Circuit(208/240/480): SPO
4. Size Disconnecting Means:
Contractor's Company Name: I. M , Xce Sevy►ee- Phone: 7%-25i- i5m8
State Certificate or Registration N. ( R- 057151 Certificate of Competency N.
Signature C Date:
(Qualffiees signature only)